Effective and Productive Instrument Processing - Friends of Hu-Friedy

Effective and Productive 

Instrument Processing 

A Peer-Reviewed Publication 

Written by Noel Brandon Kelsch, RDHAP 

Earn 

4 CE credits 

This course was 

written for dentists, 

dental hygienists, 

and assistants. 

Go Green, Go Online to take your course 

This course has been made possible through an unrestricted educational grant. The cost of this CE course is $59.00 for 4 CE credits. 

Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Educational Objectives 

The overall goal of this course is to provide information on infection control 

in the dental office. Upon completion of this course, the clinician will 

be able to do the following: 

1. Describe the chain of infection and modes of transmission of 

microorganisms in the dental office. 

2. Know and understand the four basic principles and goals to reduce 

microbial transmission. 

3. Know which instruments must be sterilized, the methods by which 

this can be achieved, and the role and importance of external and 

internal indicators on packaging. 

4. Understand instrument processing steps and the use of instrument 

management systems in this process. 

Abstract 

In order to meet the challenges of safety, time management and asepsis, 

the dental health care provider must have a plan for infection control, 

including the use and care of dental instruments and disposables. Following 

the basic CDC guidelines can help to significantly reduce the risk of 

microbial transmission. After the patient is dismissed, the operatory must 

be prepared for the next patient, including the treatment of surfaces and 

instrument processing. There is a variety of methods available to properly 

reprocess instruments. Choosing a system that minimizes risk, maximizes 

productivity and preserves instruments is essential. 

Introduction 

One of the most stressful times in dentistry can be the result of a 

single missing, damaged or nonsterile instrument. In order to meet 

the challenges of safety, time management and asepsis, the dental 

health care provider (DHCP) must have a plan for infection control, 

including the use and care of dental instruments. The plan must 

meet the guidelines of the Occupational Safety and Health Administration 

(OSHA) and the Centers for Disease Control (CDC). 

The chain of infection 

In order for a disease to occur, a number of conditions must exist. 

These conditions, called the chain of infection, are: 

1. An appropriate portal of entry for a pathogen into a new host 

2. A person who is not immune to the pathogen 

3. A pathogen in sufficient numbers to cause infection 

4. A place for the pathogen to reside and multiply 

5. A way for the pathogen to leave its reservoir and reach the 

new host 

All five conditions must be present for disease to occur. 1 

Modes of transmission 

During and following dental treatment, diseases can be transmitted 

between: 

• Patient and dental staff • Dental staff and patient 

• Patient and patient • Dental staff and dental staff 

In general, it is more likely that diseases would be transmitted 

from patients to clinicians than vice versa, because clinicians have 

frequent contact with patients’ saliva and blood during dental 

procedures. 

Occupational Exposure 

Exposure of DHCPs and patients to pathogenic microorganisms 

can result from transmission through: 

• Direct contact with blood, oral fluids, or other patient tissues 

• Direct contact of intact or nonintact skin with blood, oral 

fluids or other potentially infectious patient materials 

• Contact of conjunctival, nasal or oral mucosa with droplets 

(spray or spatter) containing microorganisms generated from 

an infected person and propelled a short distance (e.g., by 

coughing, sneezing or talking) 

• Inhalation of airborne microorganisms that can remain 

suspended in the air for long periods 1 

• Indirect contact with contaminated objects (e.g., instruments, 

equipment or environmental surfaces) 

Cross-contamination and Cross-infection 

During treatment, areas of the operatory can become contaminated 

with pathogens from blood, saliva and other body fluids. For 

example, when working with equipment such as ultrasonic scalers 

and high-speed handpieces, aerosols are created that can land on 

environmental surfaces. When the DHCP touches those surfaces, 

the microorganisms can be transferred to his or her hands. If the 

DHCP does not wash his or her hands and then touches his or her 

eyes, mouth or nose, the microorganisms can enter the provider as 

a host. If the DHCP greets a patient and shakes his or her hand, 

transfer of the bacteria or virus to the patient can also occur. This 

process, called cross-contamination or cross-infection, can place 

the DHCP and patients at risk. 2,3 

Limiting Exposure through Infection Control 

Although a DHCP’s work may increase the risk of infection, a 

number of procedures used routinely in dental settings help keep 

that risk to a minimum. 

Table 1. The Four Basic Principles 

Keep yourself healthy. This has a major impact on disease transmission. 

It emphasizes the need for dental personnel to be protected 

through immunizations, work restrictions and regular hand hygiene. 

Avoid contact with blood and body fluids. This focuses on the use of 

standard precautions, engineering controls and work practice controls. 

This principle also emphasizes the use of personal protection equipment 

(PPE) to prevent bloodborne exposure, as well as the management of 

postexposure incidents. 

Limit contamination. This involves conducting general housekeeping, 

covering and disinfecting environmental surfaces, minimizing sprays and 

splashes, properly disposing of medical waste, and maintaining water 

quality in dental unit waterlines. 4 

Make objects safe for use. Single-use items and thorough cleaning 

and sterilization of patient care items help in this area. Using instrument 

management systems can help minimize handling, sharps injuries and 

exposure. Simply placing an instrument setup into a cassette limits DHCP 

exposure to sharps and contaminated instruments and allows for a more 

automated cleaning process. 

Infection control refers to the basic principles and series of steps 

that help prevent disease transmission. Following the basic 

guidelines that the CDC has provided can help to significantly 

2 www.ineedce.com

educe the risk of microbial transmission in the dental setting. 

The goal of each of the four basic principles is to break one or 

more links in the chain of infection. 5 

Standard precautions 

Universal precautions were created in the 1980s to help protect 

against bloodborne disease transmission. In dentistry, these include 

hand washing; use of PPE such as gloves, eyewear and face 

protection; and recommendations for proper handling of patient 

care items and contaminated surfaces. As the word “universal” 

suggests, the precautions are applied when treating all patients, regardless 

of health history or presumed risk of bloodborne disease. 

In the mid-1990s, the term “standard precautions” was introduced. 

While universal precautions focus mainly on preventing 

exposure to blood, standard precautions guard against exposure to 

all body fluids (except sweat, which is not considered infectious). 6 

In the dental setting, there is little practical difference between 

universal and standard precautions. All of the precautions traditionally 

used to protect against blood and blood-contaminated 

saliva also protect against exposure to any other fluids that would 

typically be encountered in the dental setting. The DHCP should 

treat every patient as if he or she could be a source of infection. 

Using standard precautions limits cross-contamination and 

cross-infection. 7,8 Single-use surface barriers such as plastic wrap or 

sheaths prevent contamination of surfaces. 9 These barriers should 

be used on as many surfaces as possible, and especially on surfaces 

that are difficult to access or disinfect (such as X-ray tubes). The 

use of barriers is reliable, saves time and reduces exposure to 

chemicals. 10 Clinical contact surfaces that do not have barrier covers 

or become contaminated during removal of the barrier require 

surface disinfection. Disinfection should be carried out using an 

EPA-registered disinfectant with tuberculocidal activity (i.e., 

CDC intermediate-level disinfectant) or a low-level disinfectant. 

Personnel and patients rarely come in contact with housekeeping 

surfaces. These require regular cleaning to remove soil and dust. 

These areas include floors, walls and some countertops. Cleaning 

should include use of an EPA-registered hospital disinfectant with 

no tuberculocidal activity (i.e., CDC low-level disinfectant) or an 

intermediate-level disinfectant if blood is visible. 

Figure 1. Disinfection of Surfaces 

Surface 

Type 

Clinical contact 

surfaces 

Housekeeping 

surfaces 

Single-use 

barrier covers 

CDC intermediate-level 

or low-level disinfectant 

No blood present 

Blood present 

+ disinfectant if surface 

contaminated 

CDC low-level 

disinfectant 

CDC intermediate-level 

disinfectant 

In summary, with vaccination; appropriate hand hygiene; careful 

handling of sharp items; use of barrier techniques; and proper 

cleaning, disinfection and sterilization procedures, you can meet 

many requirements for a safe workplace. Instrument processing 

is a key component and, when performed appropriately, breaks 

the chain of infection, reduces DHCP stress, improves productivity 

and staff safety, and results in cost savings. 

Instrument Processing and Infection Control 

After the patient is dismissed, the operatory must be prepared 

for the next patient, including the treatment of surfaces and 

instrument processing. This process must be performed correctly 

every time to ensure items are properly processed. Having 

working, organized, sharp, debris-free and sterile (or disposable) 

instruments aids in the office’s production, the quality of 

dentistry, and the safety of patients and staff. Quality sterile 

dental instruments are key to the practice of dentistry. Choosing 

a system that minimizes risk, maximizes productivity and saves 

money is important. In addition, while some instruments must 

be disposable, limiting the disposal of reusable devices helps 

keep the world greener. Using instrument cassettes minimizes 

DHCP contact with contaminated instruments, organizes the 

instruments for safe and efficient processing, keeps the instruments 

free from debris, protects instruments from damage and 

helps instruments remain sterile after processing. Sterilization 

cassettes also standardize procedural setups by organizing the 

instruments by procedure or type of user. This standardization 

enables any staff member to quickly identify the proper cassette 

for every procedure. Cassettes help eliminate lost instruments 

during instrument processing or transportation to and from the 

operatory. Dr. Lou Graham found that by creating standardized 

setups and using the cassette system in his office, his staff saved 

an average of five minutes per procedure, which allowed the staff 

to spend more time with patients and contributed to productivity 

and therefore revenue generation. 11 Instrument processing 

requires consideration of the necessary equipment, workflow and 

stages involved. In general, the processing can be divided into a 

chairside component and a processing area component. 

Having organized, sharp, and sterile (or disposable) instruments 

aids in production, the quality of dentistry, and safety. 

Chairside Procedure 

Single-use disposable instruments 

These are designed to be used only once - for one patient and 

discarded appropriately. They cannot be cleaned, disinfected 

or sterilized. These include blades, needles, prophylaxis angles, 

carpules, cups and brushes, evacuator tips, saliva ejectors, and 

air/water syringe tips. 3 These items are becoming more and 

more available and economical. They eliminate the chance of 

cross-contamination, the need for extensive postoperative handling 

(with a risk of sharps injuries) and exposure to sterilization 

chemicals. Disposing of all single-use items immediately after 

treatment limits the risk of sharps injuries. 

The CDC recommends that there be a sharps container in every 

room in which treatment is delivered. Placing sharps in the 

container as soon as possible eliminates the hazard quickly. 

www.ineedce.com 3

Disposal of sharps and prevention of sharps injuries 

Disposing of sharps is one of the riskiest tasks in dentistry. 9,12,13 All 

operatories that include use of disposable sharps (needles, blades, 

wires, etc.) should have a sharps container in the room. 5 All sharps 

should be removed from the tray and disposed of as soon as treatment 

is completed to decrease the risk of a sharps injury. 

Figure 2. Sharps Container 

One available device melts down and compresses used needles, 

needle sheaths and red bag waste into a disposable block (Demolizer 

II, BMTS). It is approved in most states and meets EPA and 

OSHA requirements. While not reducing the risk of sharps injuries 

during the removal of sharps, it offers a disposal alternative. 

Figure 3. Demolizer 

Disposal of non-sharps patient care items 

It is important to contact your area waste management system 

to see if they allow empty carpules to go out with the general 

trash. Regulations vary by state for the disposal of intact, broken, 

blood-filled and empty carpules. Most disposable items can go 

out with the general trash. The exception is cotton materials that 

are soaked with blood to the point that blood can be wrung out 

of them. Clearing the tray of all non-sharp disposables early on 

will give the DHCP a clear view of sharps and instruments and 

decrease the likelihood of injury. 6 

The Instrument Processing Area 

The flow, layout and appropriate use of the instrument processing 

area are determining factors in successful sterilization. Office 

policy should include the use of puncture- and chemical-resistant 

utility gloves by DHCPs when cleaning dental instruments and 

working with chemicals. Latex gloves are not puncture-resistant 

and can break down in the presence of chemicals. OSHA guidelines 

specifically state, “The person handling the instruments 

through removal, cleaning, packaging and sterilization needs to 

use heavy-duty gloves to help prevent injury with sharp contaminated 

instruments.” Many DHCPs complain that heavy-duty 

gloves do not have the same tactile sensitivity as examination 

gloves. However, the fine tactile sensitivity that is needed during 

dental procedures is not necessary during instrument cleaning 

and sterilization. Additionally, some utility gloves come sized to 

meet your individual needs. 

Figure 4. Use of Utility Gloves 

The DHCP must wear proper protective equipment, including 

utility gloves, mask, glasses, and clinic gown or jacket, during 

instrument processing. Properly fitting masks, protective eye wear 

and a full gown must also be utilized to avoid contact with splashes, 

sprays and aerosols that are present in the sterilization area. The 

instrument processing area should be separated into four specific 

areas as far apart as possible and with clearly defined “clean” and 

“dirty” areas. The separate areas involved in instrument processing 

are as follows: 

Receiving, Cleaning and Decontamination 

Cassettes and instruments are placed here for removal of debris 

before processing. This area should be clearly defined to prevent 

cross-contamination. It is recommended that instrument handling 

be minimized, as this is where a high percentage of sharps 

injuries occur. Specific containers are also available for syringes, 

burs and other instruments. Handpieces must be heat-sterilized 

(autoclaved) after single patient use, and it is important to follow 

the manufacturer’s instructions on cleaning, lubrication and 

sterilizing handpieces to ensure proper sterilization and to avoid 

handpiece damage. 

Preparation and Packaging 

This area must have enough space for safe packaging and preparation. 

Supplies should be readily available to eliminate the chance 

of contaminating drawer handles and cupboards. Before preparing 

and packaging, all instruments and other patient care items should 

be inspected for cleanliness and completely dried. 

4 www.ineedce.com

Sterilization 

This is the most important area in the process. Contaminated 

items go into the sterilizer. If the sterilizer is working properly 

and the appropriate process is followed, instruments and other 

patient care items will be sterile. To prevent contamination of 

the front and handles of the sterilizer during the loading process, 

simply open the sterilizer door with a paper towel. 

Tips for Instrument Processing Areas 

• Every DHCP should have a personal set of heavy-duty utility gloves, 

disinfected and evaluated for cracks and integrity daily. This will help 

with compliance and guard against sharps injuries. 

• To prevent having to change gloves, keep a spare set of clean cotton 

forceps or a set of tongs to open and take things out of drawers and 

cupboards. 

• Keep sterilization pouches in an open, easy-to-access location to 

eliminate the risk of cross-contamination from opening drawers and 

cupboards. 

• Having the sterilizer divide the room between clean and dirty (one 

side is the dirty side, one side is the clean side) is a simple way to help 

everyone understand the concept. 

• An instrument management system that includes procedure tubs and 

cassettes is the most efficient and organized way to manage instruments 

and consumable products, and saves time. 

• Procedure tubs and cassettes limit exposure to pathogens and sharps 

injuries. 

Storage 

The storage of instruments and cassettes following sterilization 

should preserve the integrity of the packaging material. Sterilized 

items should be stored in a clean, dry environment away from 

areas where contaminated instruments are present. Do not store 

instruments or supplies under sinks, over sterilization devices, 

or in areas where moisture or environmental factors could contaminate 

the packaging. To optimize organization of supplies, 

keeping tubs for supplies in a central location is ideal. Having 

a separate tub for different procedures saves time searching for 

and gathering supplies and maximizes use of materials. A simple 

inventory list accompanying each tub will help all staff maintain 

the system easily. These tubs can act as portable operatory drawers 

for storing, organizing and transporting consumable materials 

to and from storage, the sterilization area and the operatory. 

Figure 5. Organization of Consumable Materials in Tubs 

Instrument Processing of Non-disposable Items 

Human error is the most common reason for failure. The instrument 

management process must be followed appropriately 

every time. 

Divide and conquer 

Before processing instruments, it is important to divide them into 

categories of use. Critical instruments are surgical and other instruments 

used to penetrate the mucosa and bone. This category includes 

bone chisels, scalers and burs. Critical instruments require 

heat sterilization or must be single-use disposable. Sterilization is 

achieved by steam under pressure (autoclaving), dry heat or heat/ 

chemical sterilization. Semi-critical instruments are surgical and 

other instruments that are not used to penetrate soft tissue or bone, 

but come in contact with the oral tissue. These require heat sterilization 

or, if an item is heat sensitive, immersion in a high-level 

disinfectant/sterilant. A high-level disinfectant registered with 

the EPA as a sterilant/disinfectant must be clearly labeled as such. 

Noncritical instruments are instruments that only come in contact 

with intact skin. They do not come in contact with mucosa. These 

can be sterilized by immersing them in a high-level disinfectant 

or can be processed with an intermediate-level disinfectant. Such 

devices have a relatively low risk of transmitting infection. An 

intermediate-level disinfectant will be labeled as a hospital disinfectant 

and also for tuberculocidal activity (exemplified by phenolics, 

iodophors and chlorine-based compounds). 14 

Transporting instruments 

Once all disposables and sharps are removed from the counter or 

chair tray and placed in the proper receptacles, all instruments 

should be kept in cassettes to limit handling and decrease the risk 

of sharps injury. Using instrument cassettes and sorting devices 

can make all the difference in the preparation and packaging area. 

Cassettes not only hold the instruments securely during cleaning 

and sterilization, but they also limit dulling, instrument loss, 

sharps injuries, warping of instruments and the frustration of 

trying to find missing instruments. 15 Using cassettes also helps 

avoid overloading the sterilizers with contaminated instruments, 

which can affect sterilization efficacy. Cassettes can be used for all 

instruments associated with specific procedures. A wide variety of 

cassettes is available to meet all instrument needs. Cassette accessories 

are available and sized for specific items such as burs. 

The CDC guidelines state that “contaminated instruments 

should be handled very carefully to prevent exposure to sharps 

instruments that can cause percutaneous injury. Instruments 

should be placed in an appropriate container at the point of use 

to prevent percutaneous injuries during transportation to the 

instrument processing area.” Locking, covered tubs developed 

for transport and storage of consumable materials help reduce 

exposure to cross-contamination. Using a color-coded system 

for cassettes and tubs helps organization. Tubs are available in 

colors that match cassette rails, allowing staff to match tubs and 

cassettes by procedure. For example, blue cassette rails and a blue 

tub can represent a composite procedure. All the consumable ma- 

www.ineedce.com 5

Table 2. Instrument Categories and Treatment 

Category Description Example Treatment 

Critical Instruments penetrate mucosa or bone Surgical instruments Heat sterilization 

Semi-critical Instruments come in contact with oral mucosa Handpieces Heat sterilization 

Heat-resistant instruments Heat sterilization 

Heat-sensitive instruments Immersion in high-level disinfectant/sterilant 

Non-critical Instruments come in contact with intact skin Extra-oral instruments Immersion in high-level disinfectant/sterilant or 

process in intermediate-level disinfectant 

terials for composite procedures can be stored and organized in 

the blue tub and instrumentation stored in the cassette with blue 

rails, allowing for quick identification. Hu-Friedy’s Signature 

Series Tubs and matching IMS cassette system is an example of 

this concept. Antibacterial properties such as Microban protection 

are integrated into the tub and tub components during the 

manufacturing process. Microban protection begins to work as 

soon as a microorganism comes into contact with the surface, and 

works continuously to inhibit microbial growth that can cause 

stains, odors and product degradation. Microban is registered 

with the EPA for these applications. 

Cassettes with an efficient hole pattern are preferable, as they allow 

steam and chemicals to permeate while protecting instruments 

from protrusion. Cassettes are designed to fit into ultrasonic baths and 

sterilizers— minimizing handling, saving time, increasing productivity 

and reducing the risk of infection from contaminated instruments. 

Instruments and cassettes must be transported to and from the operatory 

and sterilization area in rigid, leak-proof trays or containers. 16 

Tips for Cassettes and Tubs 

• Cassettes save time, prevent dulling of instruments and sharps 

injuries, prevent instrument loss, and reduce the chance of crosscontamination 

during transportation or processing. 

• Locking covered tubs developed for transport and storage of consumable 

materials help reduce cross contamination and protect materials 

if the tub is dropped. 

• Color-coded systems for cassettes and tubs help optimize office 

productivity and organization. 

• Antibacterial properties in tubs inhibit microbial growth, reducing 

staining and odors. 

• Matching cassette rail and tub colors by procedure allows for quick 

identification and improved workflow efficiency. 

Procedure tubs increase the efficiency of materials management 

and eliminate time-consuming tray preparation for every procedure. 

Having tubs preloaded with items for procedures such as 

endodontics, orthodontics, bonding, etc., streamlines setup and 

increases efficiency. This system eliminates the time and frustration 

of having to gather several supplies from several areas. Specially 

designed dental supply tubs with dividers are great places to 

store your spare tips and handles for instruments with replaceable 

tips and endo files. This system of organization can also include a 

simple pull tag for inventory reordering that is stored right in the 

tub. These tubs give you a clear view of the inventory and keep 

the items organized, saving you time, money and frustration. 

Precleaning solutions 

If instruments cannot be cleaned immediately, it is important to 

put them in a precleaning solution or spray them with a precleaning 

gel or foam. Leaving instruments sitting in the open air allows the 

debris to harden, making it more difficult to process. A precleaning 

solution or spray may contain enzymes to help break down debris, 

as well as rust inhibitors. Instruments should be thoroughly rinsed 

after immersion. Sterilants and high-level disinfectants should not 

be used as holding solutions. 

Figure 6. Tubs and Cassettes; Syringe Holder 

Cleaning of instruments 

Cleaning is a vital step in instrument processing. Heavily contaminated 

instruments pose a threat to personnel and patients, as 

dried blood, saliva or dental materials may insulate bloodborne 

pathogens from the direct microbial effects of heat or chemical 

sterilization. Organic contaminants also may retard or inactivate 

chemical disinfectants, contributing to corrosion and interfering 

with the instrument’s functioning. 

OSHA standards state that “all procedures involving blood or 

other potential infectious materials shall be performed in such a manner 

as to minimize splashing, spraying, spattering, and generation of 

droplets of these substances.” 17 Scrubbing instruments by hand is 

discouraged because it creates aerosols and the potential for sharps 

injuries. One 10-year study by the New York University College of 

Dentistry found that 41 percent of exposures occurred during instrument 

cleanup. 18 Risks in the receiving area and during decontamination 

can be minimized by following simple steps. Using cassettes and 

tubs and simply carrying instruments in a covered container saves 

time, costs very little and minimizes potential exposure. 9 

Automated systems are the most effective and safest method 

of decontamination, and substantially reduce instrument handling. 

4,19 Automated devices include ultrasonic cleaners and 

automated dental washers. Ultrasonic cleaners utilize sound 

6 www.ineedce.com

waves above human audibility that result in the formation of 

oscillating bubbles (cavitation) that then collapse and implode. 

Ultrasonic detergents are also available for use. More recently, 

some ultrasonic manufacturers have employed a new technology 

that uses a variable frequency as opposed to a fixed frequency in 

order to deliver reliable cavitation to all areas of the solution and 

reduce the potential for hot spots that could weaken cleaning ability. 

Additionally, some manufacturers are using materials with 

antimicrobial activity in the interior chamber of the ultrasonic 

unit. Regardless of the ultrasonic unit selected, it is important to 

suspend the instruments in a basket in the ultrasonic bath, as laying 

them flat inside the bath can result in inadequate cleaning and 

removal of debris. Also, refer to the manufacturer’s instructions 

on how much weight can been put in the ultrasonic, as it is very 

important not to overload the sterilizer. Instruments should be 

either in cassettes or loose, do not band your instruments together 

because they will not be as well cleaned. Ultrasonic baths also 

have timers, and instruments should remain in the bath for the 

full length of time recommended by the manufacturer. Enzymatic 

solutions should be changed every shift (at least daily) or more often 

if receiving heavy loads of contaminated instruments (degree 

of contamination and frequency of use are contributing factors in 

determining how often to change the ultrasonic solution). 

Instrument washers/disinfectors are a class of device traditionally 

used by central sterilization services such as those in hospitals. 

These medical devices wash, rinse and dry instruments, reducing 

the risk of pathogen transmission during subsequent instrument 

handling while processing. It is important to verify that the unit 

you are using has FDA clearance. 

Figure 7. Automated Cleaners 

Instrument examination 

Examine all instruments closely, checking for broken instruments, 

burs and debris. Remove an instrument from service if it is damaged. 

The preferred remedy when instruments do not come out of 

the ultrasonic bath or automatic washer free of debris is to run the 

instrument again to remove the debris or soak it in a presoak. If 

hand scrubbing becomes necessary: 

• Scrub one instrument at a time with a long-handled brush. 

• Do not scrub until the item has been run through a mechanical 

cleaner to remove as much organic matter as possible. 

• Hold the instrument down low in the sink, preferably under 

water, to reduce aerosol formation as much as possible. 

Tips for Instrument Cleaning and Examination 

• Presoaks and sprays prevent debris from drying or hardening on 

instruments. 

• Automated systems are the most effective and safest method of 

decontamination. 

• Test your ultrasonic bath weekly. 

Preparing and packaging, custom containers, wraps 

After cleaning the instruments, it is critical to thoroughly rinse and 

dry the instruments. Rinsing is essential to remove chemical and 

detergent residues. This prevents spotting, pitting and staining of 

instruments by detergents, which can interfere with the smooth 

operation of instruments. Splashing should be minimized during 

rinsing. Packaging cleaned, dried instruments prior to placing 

them in the sterilizer is a standard of care that protects instruments. 

Following sterilization, storing the instruments in the 

packaging maintains their sterility until they are required for use 

on patients. Unprotected instruments can be recontaminated with 

dust or spatter or by coming in contact with nonsterile surfaces 

during transport, storage and tray setup. 20 Packaging used must be 

FDA-cleared as a medical device to guarantee that the wrapping 

has been tested and is permeable to the chemical and steam. There 

are wraps available for every size of instrument. 21 Packaging is not 

reusable unless otherwise indicated, and includes plastic tubing, 

wrap, and plastic/paper pouches. In addition, color-coded instrument 

rings and cassette ID labels help organize instrument processing. 

When it is necessary to process loose instruments, these 

should be packaged so that they lie in a single layer, permitting 

exposure of all areas of the instruments to the sterilizing agent. To 

maintain integrity of the package, follow the manufacturer’s recommendations 

for sealing the package and do not use staples, pins 

or paper clips to seal packages. Do not overstuff packages. 

To maintain the integrity of packaging, follow the manufacturer’s 

instructions on sealing packages. 

The new CDC 2008 guidelines state that an internal and external 

indicator should be in each package. Companies now have 

pouches with both an internal and an external indicator. The dates 

and record of the sterilizer used if there is more than one in your 

practice, should be placed on the packaging. This is recorded so 

that if a positive spore test is obtained, all packages for the dates 

involved can be pulled. 

Figure 8. Packaging and Cassette 

www.ineedce.com 7

Sterilization Techniques 

The basic methods of sterilization of heat-tolerant instruments are 

dry heat, steam under pressure (autoclave) and unsaturated chemical 

vapor. These are done with regulated medical devices that must 

be specifically designed to meet the needs of the dental setting. 

Each method has specific advantages and should be evaluated before 

a sterilizer is chosen. Take into consideration time, exposure to 

chemicals, temperature requirements and effects on instruments. 

If the instrument is heat sensitive and is semi-critical or noncritical, 

it can be sterilized by immersing it in an EPA-registered 

high-level disinfectant/sterilant, which may require up to 10 hours. 

Surface (intermediate-level) disinfectants may not be used in place 

of high-level disinfectants/sterilants. Current CDC guidelines 

from 2008 state: “Handpieces should be heat sterilized after each 

patient. Handpieces that cannot be heat sterilized should not be 

used.” High-level disinfection with chemical germicides cannot 

be biologically monitored to assure sterility, and extended contact 

with chemical germicides may corrode handpiece components. 

Most sterilizer malfunctions are due to operator error. The 

most common reasons are inadequate space between instruments, 

improper packaging, overloading and excessive packaging. In 

one study of Minnesota dental offices, operator error rather than 

mechanical malfunction caused 87 percent of sterilization failures. 

Common factors in the improper use of sterilizers include chamber 

overload, low temperature setting, inadequate exposure time, 

failure to preheat the sterilizer and interruption of the cycle. 

Monitoring Sterilizers 

There are three basic ways to monitor the sterilizer. 22 These are: 

Mechanical Technique: This includes monitoring the cycle 

time and temperature by observing the gauges and displays during 

the process, and monitoring the computer printout, if available, to 

detect any malfunction. This should be done for every single load. 

Chemical Indicators: An indicator should be placed inside 

and outside every package or cassette. Many companies now 

manufacture packages that already contain both internal and external 

indicators. Chemical indicators are affixed on the outside of 

each package to show that the package has been processed through 

a sterilization cycle, but do not prove that sterilization has been 

achieved. A chemical indicator should also be placed on the inside 

of each package to verify sterilant penetration. 23 This distinguishes 

processed from nonprocessed items. It monitors sterilization parameters 

such as time, temperature and, for autoclaves, pressure. 

It helps to identify gross sterilizer malfunction. 24 

Biological Indicators: This test is performed at least weekly 

for both test and control spores and with every load that contains 

an implantable device. It evaluates the effectiveness of the cycle 

killing Bacillus stearothermophilus or, more recently, Geobacillus 

stearothermophilus in autoclaves and chemical vapor sterilizers. In 

dry heat systems, it tests with Bacillus subtilis and, more recently, 

Bacillus atrophaeus. Tests can be run in the office or sent out for 

processing, and directly measure the effectiveness of the sterilization 

process. All implantable items must go through this process 

before they can be placed. It is important to follow the manufac- 

turer’s steps and to use the proper test for your specific sterilizer. 

Do not use any items from a failed test. Pull all items that were 

processed during the time period following the last test that did 

not fail. 25 Sending out for processing requires up to a 14-day waiting 

period, and there is a chance of mishandling in the mail system. 

In-office biological monitoring systems are very simple to use and 

provide initial results in as little as 24 hours. In-office biological 

monitoring assures the operator that no environmental factors 

have affected the testing during mailing and allows for planning 

of delivery of items such as implants that must have biological 

monitoring confirmed before placement. 

Table 4. Advantages of an Instrument Management System 

Safety Minimizes sharps handling and instrument handling 

Reduces risk of cross-contamination due to dropped 

instruments during transportation 

Cassettes fit in ultrasonic and automatic washer/cleaners 

Tubs are rigid and leak-proof 

Safer transportation of contaminated instruments 

Sterility Organizes instruments with proper spacing for efficient 

sterilization 

Avoids overloading the sterilizer 

Keeps instruments free from debris following sterilization 

Enables safe storage after sterilization, in packaging 

Productivity, 

Efficiency 

Color-coded cassettes and tubs organize instruments and 

consumables by procedure type and are easy to identify 

Reduces set-up time with organized instrument storage 

Enhances chairside efficiency and easy staff training 

Requires less counter space than with trays 

Reduces manual sorting of instruments into pouches 

Increases available time for revenue-generating activities 

Cost Holds instruments securely during cleaning, protecting 

them from damage 

Eliminates loss of instruments during transportation 

Reduces potential for instrument damage during storage, 

transportation and processing 

Storage of instruments 

Instruments should be stored in a clean place, preferably in a 

closed drawer or cupboard, away from the area where contaminated 

instruments are held and cleaned. They should not be stored 

under sinks or above sterilization devices. All instrument packaging 

should be checked for holes and tears before use. If there are 

any problems with the packaging, the instruments should be 

recleaned, repackaged and sterilized. Unwrapped items are easily 

contaminated. Unless an item is going to be used immediately, 

it should be wrapped. Unwrapped items should not be stored in 

drawers or cabinets because they cannot be kept sterile. 7,26 

Conclusions 

Quality, sterile dental instruments are the key to the practice of 

dentistry. Having working, organized, sharp, debris-free instruments 

aids in production, quality of dentistry, safety and asepsis. 

There is a variety of methods available to reach the goal of properly 

8 www.ineedce.com

Table 3. Heat Sterilization Methods 

Method Temperature/Pressure Exposure Time (a) Advantages Precautions 

Steam autoclave (b) 121°C (250°F) 

13-30 min 

- Good penetration - Non-stainless steel items corrode 

115 kPa 

3.5-12 min 

- Nontoxic 

- May damage rubber & plastics 

134°C (273°F) 

216 kPa 

- Time efficient 

- Cannot use closed containers 

- Unwrapped items quickly contaminated after cycle 

Dry heat (c) 

160°C (320°F) 60-120 min - No corrosion 

- Long cycle time 

(oven-type) 

- Nontoxic 


- Items are dry after cycle - Door can be opened during cycle, disrupting sterilization 

- Can use closed 


containers (d) 

- Many wraps and pouches are not compatible 

Dry heat (c) 

191°C (375°F) 12 min wrapped - No corrosion 


(rapid heat transfer) 

6 min unwrapped - Nontoxic 

- Door can be opened during cycle 



- Items dry quickly 

- Many wraps and pouches are not compatible 

Unsaturated 

134°C (273°F) 216 kPa 20 min - No corrosion 


chemical vapor (b) 


- Cannot use closed containers 

- Items dry quickly 

- Must use special solution 

- Uses hazardous chemical 


(a) These exposure times relate only to the sterilization portion of the total cycle and do not include any warm-up, come-down or drying times. The exposure 

time may vary depending upon the load and should be verified during actual use with biological monitoring (spore-testing) and chemical indicators. 

(b) Monitor with spores of Bacillus stearothermophilus. 

(c) Monitor with spores of Bacillus subtilis. 

(d) Confirm by using biological indicator on inside of container. 

Adapted from: Miller, CH: Update on heat sterilization and sterilization monitoring. Compend Contin Educ Dent 1993;14:304-316. 

reprocessing instruments. Choosing a reliable, effective instrument 

management system and protocol that minimizes risk and 

stress, maximizes productivity, saves money, and limits damage to 

instruments is essential for DHCPs, patients and the practice. 

References 

1 Tortora G, Funke B, Case C. 2007. Microbiology: An Introduction (9th Edition), 

408-431. 

2 Bently CE, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination 

during dental procedures. J Am Dent Assoc. 1994;125(5):579-84. 

3 Martin MV. New Concepts in Cross-Infection Control in Dentistry. Brit Dent J. 

June 8, 1990. 

4 Miller CH, Palenik CJ. Infection Control & Management of Hazardous Materials 

for the Dental Team. 3rd Edition, Elsevier Mosby, St. Louis, Mo., 2005. 

5 CDC. Guidelines for Infection Control in Dental Health-Care Settings, 2003. 

MMWR 2003:52 (No. RR-17). 

6 CDC Guidelines: From Policy to Practice by OSAP, 2003, Annapolis, Md. 

7 Palenik CJ, Burke FJT, Coulter WA, Cheung SW. Cross-Infection Control, 

Improving and Monitoring Autoclave Performance in Dental Practice. Brit Dent J. 

1990;187:581-84. 

8 Kurita H, Kurashina K, Honda T. Nosocomial transmission of methicillinresistant 

Staphylococcus aureus via the surfaces of the dental operatory. Br Dent J. 

2006;201(5):297-300. 

9 Kohn WG, Collins AS, Cleveland JL, Jarte JA, Eklund KJ, Malvitz DM. Center for 

Disease Control and Prevention. Guidelines for infection control in dental healthcare 

settings, 2003. MMWR recomm Rep. 2003;52 (RR-17):1-16. 

10 Molinari JA, Palenik CJ. Environmental surface infection control. Compend Contin 

Ed Dent. 2004;25(suppl):30-7. 

11 Andrews, N. A Clean Sweep, RDH Magazine, Nov. 2008. 

12 Ramos-Gomez F, Ellison J, Greenspan D, Bird W, Lowe S, Gerberding JL. Accidental 

Exposures to Blood and Body Fluid Among Health Care Workers in Dental Teaching 

Clinics: A Prospective Study. J Am Dent Assoc. 1997;58(3):217-20. 

13 Panagakos FS, Silverstein J. Incidence of Percutaneous Injuries at a Dental School: 

A Four-Year Retrospective Study. Am J Infect Control. 1997;25:330-4. 

14 OSAP, Managing patient care items and environmental surfaces. (Appendix C). 

From Policy to Practice: OSAP’s Guide to the Guidelines. Annapolis, Md.: OSAP, 

2004:142. 

15 Sanchez E, Mac Donald G. Decontaminating dental instruments: testing the 

effectiveness of selected methods. J Am Dent Assoc. 1995;126;359-62. 

16 Miller CH, Palenik CJ. Infection control & management of hazardous materials for 

the dental team (3rd Edition). Elsevier Mosby, St. Louis, Mo., 2005. 

17 U.S. Department of Labor, Occupational Safety and Health Administration. 29 

CFR part 1910.1030, Occupational exposure to bloodborne pathogens, final rules. 

Federal Register 1991,56(235)64004-64182. 

18 Younai FS, Murphy CD, Kotelchuck D. Milieu in Dental Schools and Practice, 

Occupational Exposure to Blood in a Dental Teaching Environment: Results of a 

Ten-Year Surveillance Study. J Dent Ed.; 65(5):426-48. 

19 CDC. Guidelines for environmental infection control in health-care facilities: 

recommendations of the CDC and the Healthcare Infection Control Advisory 

Committee. MMWR 2003; 52(no. RR-10) Oper Dent. 2005;30(1):16-25. 

20 Organization for Safety and Asepsis: Position Paper: Instrument Processing, Jan. 

1997. Accessed Sept. 2008. 

21 Rutala WA, Weber DJ. Choosing Sterilization Wrap for Surgical Packs. Infect Cont 

Today. 2000;4:64-70. 

22 Organization for Safety and Asepsis Procedures Research Foundation. Monthly 

Focus: The Sterilization Process. Annapolis, Md.: OSAP, 1997. 

23 Centers for Disease Control. Guideline for Disinfection and Sterilization in 

Healthcare Facilities, 2008. Available at: www.cdc.gov/ncidod/dhqp/pdf/ 

guidelines/Disinfection_Nov_2008.pdf. Accessed Nov. 2008. 

24 Association of the Advancement of Medical Instrumentation. Chemical indicators: 

guidance for the selection, use and interpretation of results. AAMI Technical 

Information Report No 25. Arlington, Va.: Association for the Advancement of 

Medical Instrumentation, 1999. 

25 Nickerson P, Bhuta G, Orton B, Alvin B. Monitoring dental sterilizers’ effectiveness 

using biological indicators. J Dent Hyg. 1990;64(2):69-73. 

26 Rosa AC et al. Effects of Handling and Storage on Sterile Dental Instruments. Acta 

Odontol Lainoam. 2001;14(1-2):35-39. 

Author Profile 

Noel Brandon Kelsch, RDHAP 

Noel Brandon Kelsch is a freelance cartoonist, writer, international speaker and 

Registered Dental Hygienist in Alternative Practice. Her articles have been published 

in dental and nursing trade magazines. She has written articles for National 

Journals and Corporations on Methamphetamine abuse. Her passion for getting 

information to the dental professional and the public on the oral effects of this 

devastating drug has taken her from NBC news to ESPN. Noel has received many 

national awards including Colgate Bright Smiles Bright Futures, RDH Magazine 

Sun Star Butler Award of Distinction, USA magazine Make a Difference Day 

award, Presidents Service award, Foster Parent of the Year, and is a five-time winner 

of the Castroville Artichoke cook off! Noel is the current President of California 

Dental Hygienists Association, a member of Organization for Safety and Asepsis 

Procedures and board member of Simi Valley Free Clinic. 

Disclaimer 

The author(s) of this course has/have no commercial ties with the sponsors or the 

providers of the unrestricted educational grant for this course. 

Reader Feedback 

We encourage your comments on this or any PennWell course. For your convenience, an 

online feedback form is available at www.ineedce.com. 

www.ineedce.com 9

1. The conditions that must exist in order for a 

disease to occur are called the ________. 

a. chance of infection 

b. chain of transmission 

c. chain of infection 

d. none of the above 

2. In general, it is more likely that disease 

would be transmitted from clinician to 

patient than vice versa. 

a. True 

b. False 

3. Indirect contact with pathogenic microorganisms 

in the dental setting does not lead to 

disease transmission. 

a. True 

b. False 

4. Standard precautions guard against 

exposure to _________. 

a. blood 

b. blood and saliva 

c. blood and sweat 

d. all body fluids except sweat 

5. The DHCP should treat every patient as a 

potential source of infection. 

a. True 

b. False 

6. Single-use surface barriers _________. 

a. protect surfaces from contamination 

b. should be used on as many surfaces as possible 

c. reduce exposure to chemicals 

d. all of the above 

7. Instrument processing is a key component of 

infection control. 

a. True 

b. False 

8. Using instrument cassettes _________. 

a. protects instruments 

b. limits DHCP contact with contaminated instruments 

c. keeps instruments free of debris 


9. Using standardized set-ups and an instrument 

cassette system saves time in the dental 

office and helps increase productivity. 

a. True 

b. False 

10. If necessary, single-use disposable instruments 

can be sterilized. 

a. True 

b. False 

11. A sharps container should be kept in a central 

location rather than in each operatory. 

a. True 

b. False 

12. One available device that melts down and 

compresses used needles ________. 

a. helps reduce sharps injuries during sharps removal and 

offers a disposal alternative 

b. offers a disposal alternative 

c. meets OSHA and EPA requirements 

d. b and c 

Questions 

13. In all states, intact, broken and empty 

carpules can be disposed of in the general 

trash. 

a. True 

b. False 

14. Puncture- and chemical-resistant utility 

gloves _________. 

a. should be worn during instrument processing by the 

DHCP handling contaminated instruments 

b. should be inspected at least daily for cracks and integrity 

c. are a requirement based on OSHA guidelines 


15. Cassettes and instrument trays are placed 

in the _________ area for removal of debris 

before processing. 

a. sterilization 

b. receiving, cleaning and decontamination 

c. prepping 

d. any of the above 

16. An instrument management system that 

includes the use of instrument tubs and 

cassettes is the most efficient way to manage 

consumable products and instruments. 

a. True 

b. False 

17. A biological indicator test is performed 

_________ for test and control spores. 

a. daily 

b. weekly 

c. monthly 

d. as often as deemed necessary, depending on the 

infection risk from a given office’s patients 

18. To save storage space, sterilized instruments 

may be carefully stored in their 

packaging above the sterilizer. 

a. True 

b. False 

19. Critical instruments _________. 

a. require heat sterilization or must be single-use 

disposable 

b. require chemical or heat sterilization or must be 

single-use disposable 

c. require disinfection or must be single-use disposable 

d. must be disposable 

20. Antibacterial properties incorporated into 

instrument tubs _________. 

a. ensure that no cross-infection is possible 

b. help prevent odors and staining of the tub 

c. help prevent degradation of the tub 

d. b and c 

21. Cassettes with an efficient hole pattern 

_________. 

a. allow steam to permeate the cassette 

b. allow chemicals to permeate the cassette 

c. protect instruments from protrusion 


22. A precleaning solution may contain 

enzymes to help break down debris, as well 

as rust inhibitors. 

a. True 

b. False 

23. One ten-year study found that _________ 

of sharps injury exposures occurred during 

instrument cleaning. 

a. 21 percent 

b. 31 percent 

c. 41 percent 

d. 51 percent 

24. Automated systems are the safest and most 

effective method of instrument reprocessing. 

a. True 

b. False 

25. After cleaning the instruments, it is critical 

to thoroughly rinse and dry the instruments. 

a. True 

b. False 

26. Regular wrapping paper can be used for 

instrument packaging. 

a. True 

b. False 

27. The new CDC guidelines of 2008 state that 

packaging must have __________. 

a. an external indicator 

b. an internal indicator 

c. a lateral indicator 

d. both an external and an internal indicator 

28. According to the 2008 CDC guidelines, 

handpieces can be chemically sterilized if 

they are heat-sensitive. 

a. True 

b. False 

29. Sterilizers can be monitored using 

__________. 

a. mechanical techniques 

b. biological indicators 

c. chemical indicators 


30. A reliable, effective instrument management 

system used as part of an infection 

control program _________. 

a. minimizes risk 

b. maximizes productivity 

c. limits damage to instruments 


10 www.ineedce.com

AUTHOR DISCLAIMER 

The author(s) of this course has/have no commercial ties with the sponsors or the providers of 

the unrestricted educational grant for this course. 

SPONSOR/PROVIDER 

This course was made possible through an unrestricted educational grant from Hu- 

Friedy, Inc.. No manufacturer or third party has had any input into the development of 

course content. All content has been derived from references listed, and or the opinions 

of clinicians. Please direct all questions pertaining to PennWell or the administration of 

this course to Machele Galloway, 1421 S. Sheridan Rd., Tulsa, OK 74112 or macheleg@ 

pennwell.com. 

COURSE EVALUATION and PARTICIPANT FEEDBACK 

We encourage participant feedback pertaining to all courses. Please be sure to complete the 

survey included with the course. Please e-mail all questions to: macheleg@pennwell.com. 

ANSWER SHEET 

Effective and Productive Instrument Processing 

Name: Title: Specialty: 

Address: E-mail: 

City: State: ZIP: Country: 

Telephone: Home ( ) Office ( ) 

Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all 

information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn 

you 4 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. 

Educational Objectives 

1. Describe the chain of infection and modes of transmission of microorganisms in the dental office 

2. Know and understand the four basic principles and goals to reduce microbial transmission 

3. Know which instruments must be sterilized, the methods by which this can be achieved, and the role and importance of 

external and internal indicators on packaging 

4. Understand instrument processing steps and the use of instrument management systems in this process. 

Course Evaluation 

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0. 

1. Were the individual course objectives met? Objective #1: Yes No Objective #3: Yes No 

Objective #2: Yes No Objective #4: Yes No 

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0 

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0 

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0 

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0 

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0 

7. Was the overall administration of the course effective? 5 4 3 2 1 0 

8. Do you feel that the references were adequate? Yes No 

9. Would you participate in a similar program on a different topic? Yes No 

10. If any of the continuing education questions were unclear or ambiguous, please list them. 

___________________________________________________________________ 

11. Was there any subject matter you found confusing? Please describe. 

___________________________________________________________________ 

___________________________________________________________________ 

12. What additional continuing dental education topics would you like to see? 

___________________________________________________________________ 

___________________________________________________________________ 

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS. 

INSTRUCTIONS 

All questions should have only one answer. Grading of this examination is done 

manually. Participants will receive confirmation of passing by receipt of a verification 

form. Verification forms will be mailed within two weeks after taking an examination. 

EDUCATIONAL DISCLAIMER 

The opinions of efficacy or perceived value of any products or companies mentioned 

in this course and expressed herein are those of the author(s) of the course and do not 

necessarily reflect those of PennWell. 

Completing a single continuing education course does not provide enough information 

to give the participant the feeling that s/he is an expert in the field related to the course 

topic. It is a combination of many educational courses and clinical experience that 

allows the participant to develop skills and expertise. 

COURSE CREDITS/COST 

All participants scoring at least 70% (answering 21 or more questions correctly) on the 

examination will receive a verification form verifying 4 CE credits. The formal continuing 

education program of this sponsor is accepted by the AGD for Fellowship/Mastership 

credit. Please contact PennWell for current term of acceptance. Participants are urged to 

contact their state dental boards for continuing education requirements. PennWell is a 

California Provider. The California Provider number is 4527. The cost for courses ranges 

from $49.00 to $110.00. 

Many PennWell self-study courses have been approved by the Dental Assisting National 

Board, Inc. (DANB) and can be used by dental assistants who are DANB Certified to meet 

DANB’s annual continuing education requirements. To find out if this course or any other 

PennWell course has been approved by DANB, please contact DANB’s Recertification 

Department at 1-800-FOR-DANB, ext. 445. 

For IMMEdIATE results, 

go to www.ineedce.com to take tests online. 

Go to www.ineedce.com 

ENTER COUPON CODE: 

FHUF0609 

in coupon section of 

shopping cart. 

Click Apply 

Follow Prompts 

AGD Code 148 

RECORD KEEPING 

PennWell maintains records of your successful completion of any exam. Please contact our 

offices for a copy of your continuing education credits report. This report, which will list 

all credits earned to date, will be generated and mailed to you within five business days 

of receipt. 

CANCELLATION/REFUND POLICY 

Any participant who is not 100% satisfied with this course can request a full refund by 

contacting PennWell in writing. 

© 2009 by the Academy of Dental Therapeutics and Stomatology, a division 

of PennWell 

INFC0903HF 

www.ineedce.com 11

It’s difficult to perform when 

you’re missing an instrument. 

Chairside efficiency means having all the instruments you need right at your fingertips. 

Many dental practitioners have found this easy to accomplish once they’ve integrated Hu-Friedy’s Instrument 

Management System (IMS) into their practice. The IMS cassette system is designed to keep your instruments 

organized and intact from cleaning to chairside. It eliminates instrument scrubbing and sorting, protects 

against breakage, and reduces the risk of injury. Dental practitioners believe the most 

convincing selling point for IMS Cassettes is saving 5 to 10 minutes per procedure. 

Call 1-800-HU-FRIEDY or contact your authorized Hu-Friedy dealer for more information. www.hu-friedy.com IMS-414/10M/04-09

Effective and Productive Instrument Processing - Friends of Hu-Friedy

Create successful ePaper yourself

Delete template?

Save as template?